Breathing-Related Sleep Disorders
DSM-IV In DSM-IV, this is a disorder called Breathing-Related Sleep Disorder Diagnostic Criteria A'''. Sleep disruption, leading to excessive sleepiness or insomnia, that is judged to be due to a sleep-related breathing condition (e.g., obstructive or central sleep apnea syndrome or central alveolar hypoventilation syndrome). '''B. The disturbance is not better accounted for by another mental disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another general medical condition (other than a breathing-related disorder). Differential Diagnosis Narcolepsy, Primary Hypersomnia, and Circadian Rhythm Sleep Disorder Breathing-Relating Sleep Disorder must be differentiated from other causes of sleepiness, such as Narcolepsy, Primary Hypersomnia, and Circadian Rhythm Sleep Disorder. Breathing-Related Sleep Disorder can be differentiated from Narcolepsy by the absence of cataplexy, sleep-related hallucinations, and sleep paralysis and by the presence of loud snoring, gasping during sleep, or observed apneas or shallow breathing in sleep. Daytime sleep episodes in Narcolepsy are characteristically shorter, more refreshing, and more often associated with dreaming. Breathing-Related Sleep Disorder shows characteristic apneas of hypoventilation during nocturnal polysomnographic studies, and Narcolepsy results in multiple sleep-onset REM periods during the MSLT. Some individuals have concurrent Narcolepsy and Breathing-Related Sleep Disorder. Breathing-Related Sleep Disorder may be distinguished from Primary Hypersomnia and Circadian Rhythm Sleep Disorder baed on the presence of clinical or laboratory findings of obstructive sleep apnea, central sleep apnea, or central alveolar hypoventilation syndromes. Definitive differential diagnosis between Primary Hypersomnia and Breathing-Related Sleep Disorder may require polusomnographic studies. Hypersomnia related to a Major Depressive Episode Hypersomnia related to a Major Depressive Episode can be distinguished from Breathing-Related Sleep Disorder by the presence or absence of other characteristic symptoms (e.g., depressed mood and loss of interest in a Major Depressive Episode and snoring and gasping during sleep in Breathing-Related Sleep Disorder). Asymptomatic adults who snore Individuals with Breathing-Related Sleep Disorder must also be differentiated from otherwise asymptomatic adults who snore. This differentiation can be made based on the presenting complaint of insomnia or hypersomnia, the greater intensity of snoring, and the presence of the characteristic history, signs, and symptoms of Breathing-Related Sleep Disorder. Primary Insomnia For individuals complaining of insomnia, Primary Insomnia can be differentiated from Breathing-Related Sleep Disorder by the absence of complaints (or reports from bedpartners) of difficulty breathing during sleep and the absence of the history, signs, and symptoms characteristic of Breathing-Related Sleep Disorder. Nocturnal Panic Attacks Nocturnal Panic Attacks may include symptoms of gasping or choking during sleep that may be difficult to distinguish clinically from Breathing-Related Sleep Disorder. However, the lower frequency of episodes, intense autonomic arousal, and the lack of excessive sleepiness differentiates nocturnal Panic Attacks from Breathing-Related Sleep Disorder. Polysomnography in individuals with nocturnal Panic Attacks does not reveal the typical pattern of apneas, hypoventilation, or oxygen desaturation characteristic of Breathing-Related Sleep Disorder. General Medical Condition The diagnosis of Breathing-Related Sleep Disorder is appropriate in the presence of a general medical condition that causes insomnia or hypersomnia through the mechanism of impaired ventilation during sleep. For example, an individual with tonsillar hypertrophy who has sleep difficulty related to snoring and obstructive sleep apneas should receive a diagnosis of Breathing-Related Sleep Disorder and tonsillar hypertrophy. In contrast, Sleep Disorder Due to a General Medical Condition is appropriate if a general medical or neurological condition causes sleep-related symptoms through a mechanism other than breathing disturbance. For instance, individuals with arthritis or renal impairments may complain of insomnia or hypersomnia, but this does not result from breathing impairment during sleep. Substance Use or Withdrawal The use of, or withdrawal from, substances (including medications) can produce insomnia or hypersomnia similar to that in Breathing-Related Sleep Disorder. A careful history is usually sufficient to identify the relevant substance, and follow-up shows improvement of the sleep disturbance after discontinuation of the substance. In other cases, the use of a substance (e.g., alcohol, barbiturates, or benzodiazepines) can exacerbate Breathing-Related Sleep Disorder. An individual with symptoms and signs consistent with Breathing-Related Sleep Disorder should receive that diagnosis, even in the presence of concurrent substance use that is exacerbating the condition. DSM-5 Disorders # Obstructive Sleep Apnea Hypopnea # Central Sleep Apnea # Sleep-Related Hypoventilation